Individual
KELLY VAN DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1202 W CHEROKEE ST STE H, WAGONER, OK 74467-4629
(918) 614-5533
(918) 485-6020
Mailing address
10907 S KNOXVILLE AVE, TULSA, OK 74137-6624
(918) 978-5588
(918) 299-0323
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
23418
OK
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
23418
OK
207RR0500X
Rheumatology Physician
23418
OK
Other
Enumeration date
03/28/2006
Last updated
10/14/2022
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